Prevalence and Factors Related to Post-traumatic Stress Disorder and Depression Symptoms Among Children and Adolescents Survivors and Orphans of Ebola Virus Disease in Democratic Republic of the Congo Eastern Regions During the COVID-19 Pandemic

PURPOSE

Although previous studies have shown a high prevalence of mental health problems among adult Ebola virus disease survivors, no studies have yet been conducted on mental health problems among children and adolescents in affected regions. Consequently, the current study aimed to examine the prevalence and factors associated with depression and post-traumatic stress disorder (PTSD) among children and adolescent survivors and orphans by utilizing a cross-sectional survey following the 2018-2020 epidemic in Eastern Democratic Republic of the Congo.

METHODS

A total of 146 survivors (mean age = 13.62, standard deviation [SD] = 2.50, 49.32% female), 233 orphans (mean age = 13.18, SD = 2.96, 53.32% female), and 34 orphan-survivor participants (mean age = 13.39, SD = 2.87, 44.12% female) were recruited. Participants completed measures assessing depression and PTSD symptoms, traumatic experiences, and stigma related to Ebola and COVID-19.

RESULTS

The prevalence of depression and PTSD symptoms was 87.32% and 44.42%, respectively. Results showed significant differences in depression and PTSD symptoms between orphan-survivors (100% and 97.06%), survivors (90.21% and 75.86%), and orphans (83.48% and 16.52%; χ2(2) = 9.02; p = .011 and χ2(2) = 168.85; p < .001). Experience of traumatic events, Ebola stigmatization, and COVID-19 stigmatization positively predicted depression and PTSD symptoms. The regression models explained 61%-72% of the variance of depression and PTSD.

DISCUSSION

The results reveal that the Ebola virus disease and its associated grief severely jeopardize the mental health of children and adolescents in affected regions. Despite the relative paucity of resources, intervention programs may be helpful to minimize associated stigma and promote psychological support.

Prevalence and determinants of anxiety, depression and comorbid anxiety-depression symptoms among adolescents in Ebola-affected zones

BACKGROUND

Ebola virus disease (EVD) has been shown to be associated with poor mental health in affected zones. However, no study has yet explored its impact on adolescents' mental health.

AIMS

This study aimed to assess the prevalence and risk factors associated with depression and anxiety symptoms among adolescents in EVD-affected areas in the Equateur Province of the Democratic Republic of the Congo during the COVID-19 pandemic.

METHOD

A provincial sample of adolescents aged 12-17 years (M = 14.84, s.d. = 1.49) living in the 18 urban and rural areas affected by the 2018 EVD outbreak completed a two-wave longitudinal survey. Surveys assessed symptoms of depression and anxiety, exposure to Ebola, social support and sociodemographic information.

RESULTS

A total of 490 participants completed the baseline and follow-up surveys, 50% of whom were female. Elevated and worsened depressive symptoms were observed among participants from the baseline (56.94%) to the follow-up (91.43%; z = -11.37, P < 0.001), whereas anxiety symptoms decreased from the baseline (36.33%) to follow-up (24.90%; z = 4.06, P < 0.001). The final generalised estimating equation model showed that anxiety symptoms decreased over time (B = -3.92, P < 0.001), while depression symptoms increased (B = 4.79, P < 0.001). Stigmatisation related to Ebola positively predicted anxiety (B = 5.41, P < 0.001) and depression symptoms (B = 0.4452, P = 0.009). Social support negatively predicted anxiety (B = -1.13, P = 0.004) and depression (B = -0.98, P < 0.001) symptoms but only moderated the association between stigmatisation and depression symptoms (B = -0.67, P < 0.001).

CONCLUSIONS

Most adolescents living in EVD-affected areas experience mental health issues. Stigmatisation related to EVD and living in urban areas are the most consistent predictors of mental health problems. Nevertheless, social support remains a protective factor for depression and anxiety symptoms and a necessary resource for building resilience.

Enacted Ebola Stigma and Health-related Quality of Life in Post Ebola Epidemic: A Psychosocial Mediation Framework Through Social Support, Self-Efficacy, and Coping

On-site experiences and reports have shown that the multiple outbreaks of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) resulted in pervasive experience of stigma against many people who have recovered from EVD as well as their families and close relatives. Three evidence-based protective factors which are supposed to mitigate the impact of enacted Ebola stigma on health-related quality of life (HRQoL) of individuals in this epidemic context were identified. We expected that positive religious coping, perceived social support, and general self-efficacy would mediate the relationship between enacted Ebola stigma and HRQoL. These hypotheses were tested through multiple mediation model using the structural equation modeling among a large sample of adult populations (N = 1614; 50% women) in the province of Equateur in the DRC, in the aftermath of the 9th Ebola outbreak. The mediation model yielded adequate fit statistics and the results provided strong evidence that higher levels of enacted Ebola stigma were associated with lower HRQoL. They confirmed the synergetic mediating effects of positive religious coping, perceived social support from family (but not from others sources) and general self-efficacy. Futher exploratory findings revealed that the perceived social support from family buffered the impact of enacted Ebola stigma on HRQoL. If replicated by a longitudinal study, our findings lay a solid foundation for empirical-based community mental health interventions for reducing enacted Ebola stigma and promoting HRQoL during epidemics, especially in the DRC.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo

BACKGROUND

Associated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo.

METHODS

Surveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes.

RESULTS

Prevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distress_T1= 57.04%, Mental distress_T2= 40.29%, x²= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001).

CONCLUSIONS

Although a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

Migration experience and mental health: A qualitative study in France and Brazil

BACKGROUND

The relationship between migration and mental health is complex and involves factors at different levels, as the individual history of the migrant, the collective history of their home country, the host society's and their mutual past history. Even though the migratory scenario of France and Brazil has changed over the years, both countries currently host an important number of immigrants.

AIM

The main objective of the present study was to describe and analyze the impacts of the migratory experience on mental health of migrants with different migration experiences and living in two countries: France and Brazil.

METHOD

Semi-structured interviews were conducted with 13 participants, six in France and seven in Brazil. A thematic qualitative analysis of the data was performed using the ATLAS.TI software. Three themes were created based on the different times of the migration experience: before migration, during migration and after migration. All codes of these three bigger themes were organized in sub-themes for the samples in France and Brazil.

RESULTS

Participants in France described an important exposure to traumatic events before and during migration. In Brazil, the migration experiences were multiple, in some cases presenting a traumatic history, but in most cases migration was seen as an opportunity to have access to better life conditions. In both countries, participants reported a great level of psychological distress associated to post-migratory difficulties (e.g. unemployment, learning a new language, or facing a new cultural environment).

CONCLUSIONS

Our results suggest that multidisciplinary interventions, with focus on skills development, such as language and work-related skills, and on access to basic needs may be essential for both voluntary and involuntary migrants. In addition to these interventions, some individuals may need specialized mental health intervention, focusing in past traumatic exposure and in the current acculturation process.

Prevalence and risk factors of depression symptoms among rural and urban populations affected by Ebola virus disease in the Democratic Republic of the Congo: a representative cross-sectional study

OBJECTIVES

High mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD.

DESIGN

Cross-sectional study.

SETTING

The current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC).

PARTICIPANTS

A large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions.

RESULTS

Overall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms.

CONCLUSIONS

Results indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.

Corrigendum: The Transcultural Community Resilience Scale: Psychometric Properties and Multinational Validity in the Context of the COVID-19 Pandemic

[This corrects the article DOI: 10.3389/fpsyg.2021.713477.].

Ebola virus disease, stigmatization, peritraumatic distress, and posttraumatic stress disorder in the Democratic Republic of the Congo: A moderated mediation model

BACKGROUND

Mechanisms worsening the development of Posttraumatic stress disorder (PTSD) symptoms among individuals affected by high-mortality epidemics are unclear. This study examined the prevalence of PTSD and related risk factors among populations affected by the Ebola virus disease (EVD) outbreak, and investigated whether peritraumatic distress mediates the impact of exposure level to EVD on PTSD symptoms, and the moderation role of stigmatization.

METHODS

The sample included 1614 participants (50% women) affected by EVD in Democratic Republic of the Congo (DRC). Participants completed the PTSD Check-List for DSM-5, Peritraumatic Distress Inventory, and measures evaluating levels of exposure and stigmatization related to EVD. Descriptive analyses and a moderated mediation model were computed.

RESULTS

A total of 58.81% participants (95% CI: 56.41%; 61.21%) met PTSD diagnostic criteria. Participants living in rural areas presented greater risk, while there is no significant difference between men and women. Peritraumatic distress mediated partially the association between exposure to EVD and PTSD symptoms. Moreover, this relationship was moderated by stigmatization related to EVD.

LIMITATIONS

As the design was cross-sectional, this study could not examine the causality of PTSD symptoms among communities affected by EVD.

CONCLUSIONS

This study shows high prevalence rates and important risk factors associated with PTSD in populations affected by EVD. It indicates elements that could help to develop and implement prevention and intervention programs in affected communities.

The Transcultural Community Resilience Scale: Psychometric Properties and Multinational Validity in the Context of the COVID-19 Pandemic

Few instruments assess community resilience. In the midst of the COVID-19 pandemic, the capacity of communities to support resilience of members deserves to be assessed to develop programs for improving mental health of affected populations. This article presents the development of the Ottawa-Community Resilience Scale (O-CRS), its underlying factorial structure and transcultural validity with a multilingual (English, French, Creole, Kinyarwanda), multinational (DR Congo, Haiti, Rwanda, Togo) and multicultural sample affected by this pandemic. A sample of 1,267 participants (40.9% women) were recruited in the four countries: DRC (n = 626, 43.4% women), Haiti (n = 225, 42.0% women), Rwanda (n = 174, 40.5% women), and Togo (n = 242, 33.2% women), with a mean age of 32 (SD = 10.1). They completed measures assessing individual resilience, depression and the O-CRS. Exploratory and confirmatory Factor Analyses, Cronbach alpha, coefficient H and the McDonald's Omega, and bivariate regression were used to estimate the underlying components of the O-CRS, its internal consistency and concurrent validity. Parallel factorial analysis and confirmatory factor analysis results revealed an excellent fit 3-factor structure. Internal consistency coefficients varied between 0.82 and 0.95. The O-CRS showed a good construct validity with a positive association with individual resilience and negative association with depression score. Developed with a collaborative approach involving researchers, practitioners, and clients/patients, the O-CRS and its three factors (community strengths and support, community trust and faith, and community values) demonstrated excellent psychometric properties for assessing community resilience among adults during the COVID-19 pandemic.

Polyvictimization and Cybervictimization Among College Students From France: The Mediation Role of Psychological Distress and Resilience

Few studies have explored potential associations between polyvictimization and cybervictimization and even fewer have involved in college-age sample. As it has been shown in the literature, polyvictimization is associated with higher psychological distress and lower resilience. This study is aimed to model the association between polyvictimization and cybervictimization by testing the mediating role of psychological distress and resilience. The sample included 4,626 undergraduates from France. Participants completed questionnaires assessing cybervictimization, polyvictimization (emotional abuse from parents, exposure to interparental violence, parental neglect, unwanted sexual touching, and unwanted sexual intercourse), psychological distress, and resilience. Results show that each form of victimization considered was significantly associated with cybervictimization. Also, polyvictimized participants presented higher prevalence of cybervictimization. The association between polyvictimization and cybervictimization was partially mediated positively by psychological distress and negatively by resilience. In fact, more cybervictimization was observed among polyvictimized participants with a high score of psychological distress, whereas fewer cybervictimization was observed in those with a high score of resilience. This study provides a new understanding of the mechanisms involved in cybervictimization that can help to better prevent and intervene with victims. Our results suggest that mental health professionals should assess childhood experiences of victimization when they are working with cybervictims. They also suggest the need for mental health professionals to help both polyvictimized and cybervictimized youth to develop resilience skills and coping strategies.

Does peritraumatic distress predict PTSD, depression and anxiety symptoms during and after COVID-19 lockdown in France? A prospective longitudinal study

BACKGROUND

COVID-19 peritraumatic distress (CPD), an emerging trauma-related psychopathology, involves immediate physiological arousal as well as emotional and cognitive responses to the threat of the COVID-19 outbreak. This study examined the prevalence of and temporal changes in CPD, its early and follow-up predictors and the extent to which it was predictive of mental health problems.

METHODS

The study took a two-wave design approach and was conducted during and 3-4 months after the nationwide lockdown in France. Baseline participants were 1123 (79.5% women; M age = 33.82; range: 18-80). They completed validated measures assessing CPD, posttraumatic stress (PTS), depression, and anxiety symptoms. Descriptive, correlational, and path model analyses were used.

FINDINGS

Both baseline and follow-up groups presented similar psychosocial profiles. Overall, 35.5% (95% Confidence Interval [CI]: 32.7-38.4) baseline participants and 17.2% (95% CI: 12.6-22.7) follow-up participants developed clinical cases of CPD. The baseline CPD levels predicted 14-20% of the variances of PTS (b = 0.55), depression (b = 0.16) and anxiety symptoms (b = 0.16). After accounting for the effect of the baseline CPD levels, the current CPD levels predicted the three investigated mental health outcomes in high proportions (43-47%). Further findings revealed important temporal changes in baseline predictors of CPD. However, the chronic CPD and PTS symptoms were prevalent among students and individuals developing worries about the COVID-19 crisis while depression and anxiety symptoms were prevalent among single people and those with pre-existing mental health problems.

LIMITATIONS

Data from self-report measures of mental health were used. The dropout rate between the two time assessments was relatively high.

CONCLUSIONS

These longitudinal findings call for clinical efforts in assessment of and intervention in trauma-related distress. These efforts should be put into the predictive role of CPD in subsequent development of PTS symptoms and comorbidities as long as the health, social and economic consequences of the pandemic linger.

Prolonged grief and depression: A latent class analysis

Recent trends in grief research have been exploring how symptoms of prolonged grief disorder (PGD) and depression co-occur in bereaved individuals using Latent Class Analysis (LCA). However, the PGD criteria have kept undergoing changes and the newest DSM-5 PGD criteria have not been captured in these studies. Also, previous LCA-grief studies have been conducted in Western cultures, focusing more on bereaved adult populations. In this study, we applied LCA on a non-Western sample of bereaved young and middle-aged adults to examine whether the consistently observed 3 latent classes will emerge. We explored if the socio-demographic, loss-related factors, religiousness, spirituality, and continuing bond to the deceased, differentiated the latent classes. We confirmed the 3 latent classes comprising the Resilient class (20.6%), the predominantly PGD class (44.7%), and the combined PGD and Depression class (34.7%). Age, time elapsed since the loss, continuing bond and relationship with the deceased as well as spiritual beliefs were the differential predictors of class membership. This study increases our conceptual and clinical understanding of the predictability of PGD symptomology outcome, according to the newest DSM-5 criteria following bereavement in a non-Western sample. In addition to the continuing bond which was the strongest correlate, attention should be paid to important sociocultural frameworks in grief management.

Prevalence and associated mental health outcomes of child sexual abuse in youth in France: Observations from a convenience sample

CONTEXT

Child sexual abuse (CSA) is an important public health problem associated with an array of negative consequences. Although prevalence rates are well established from North America, few studies have focused on the extent of CSA and associated outcomes in youth from France.

OBJECTIVES

This study aimed to: 1) estimate the prevalence of CSA, 2) assess the associations between CSA and health outcomes while exploring possible gender specificities and 3) document the contribution of revictimization on symptom complexity.

METHOD

The sample involved 2309 participants aged between 14 and 23 years old (M = 19.55). Measures assessing CSA, other forms of child maltreatment and mental health problems were administered. Sexual revictimization and a host of protective factors (resilience, coping strategies, parental support) were also assessed.

RESULTS

CSA was reported by 13.1% of girls and 4.2% of boys. Regression analyses revealed that CSA was associated with all mental health outcomes except alcohol and drug use (other than cannabis) after controlling for sociodemographics and other forms of child maltreatment. Sexual revictimization was associated with symptom complexity. Emotion-centered and avoidance coping predicted symptom complexity while resilience and paternal support acted as protective factors.

LIMITATIONS

The study relied on a cross-sectional design with a convenience sample, which limits the generalizability of results. The small number of boys reporting CSA precludes drawing firm conclusions as to the gender specificities in the outcomes associated with CSA.

CONCLUSIONS

Findings underscore the relevance of developing efficient prevention programs as CSA is linked to a host of negative outcomes.

Psychological distress among adults from the urban and rural areas affected by the Ebola virus disease in the Democratic Republic of the Congo

PURPOSE

Ebola virus disease (EVD) is associated with high anxiety and multiple bereavement that can induce severe psychological distress (SPD) in individuals living in affected communities. Using data from the EVD and Mental Health project (EboMH), this study assessed the prevalence and determinants of SPD symptoms in a representative sample of adults in communities affected by EVD.

METHODS

A representative sample of 1614 adults (50% women) aged 18-85 years completed measures assessing exposure level to EVD, stigmatization related to EVD, and psychological distress.

RESULTS

In total, 45.58% of individuals from the cities and villages affected by EVD reported SPD. Results showed significant differences for residence area, employment, age, education level, and religion, but not for gender. Exposure level to EVD (β = 0.11, p < 0.001; OR = 1.12, 95% CI [1.08-1.16]), stigmatization related to EVD (β = 0.06, p < 0.001; OR = 1.06, 95% CI [1.05-1.07]), and living in rural areas (β = 0.67, p < 0.001; OR = .51, 95% CI [.36-.72]) predicted SPD symptoms.

CONCLUSIONS

Evidence-based global mental health programs in high-risk mortality epidemic contexts should take into account the high psychological distress in the affected areas.

Frequency and correlates of anxiety symptoms during the COVID-19 pandemic in low- and middle-income countries: A multinational study

OBJECTIVE

Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic.

METHODS

A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety.

RESULTS

Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x² = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (β = 0.06, p = .005), stigmatization related to COVID-19 (β = 0.03, p < .001), and resilience (β = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (β = 0.02, p < .00; β = 0.05, p = .013; β = 0.03, p = .021; β = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo).

CONCLUSIONS

The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.

Sexual victimization, PTSD, depression, and social support among women survivors of the 2010 earthquake in Haiti: a moderated moderation model

BACKGROUND

In 2010, an important earthquake devastated Haiti and caused thousands of deaths. In a social context where women are particularly vulnerable, this cross-sectional study examined the associations between sexual assaults experienced by women before the earthquake, the earthquake exposure, the traumatic consequences, and their satisfaction of social support received.

METHODS

A total of 660 women aged 18 to 86 completed questionnaires assessing exposure to the earthquake, sexual assault victimization, peritraumatic distress, Posttraumatic stress disorder (PTSD), depression, and social support. A moderated moderation model was computed to examine associations between exposure to the earthquake, sexual assault, social support, and traumatic consequences.

RESULTS

Results showed that 31.06% of women were victims of sexual assault before the earthquake. They presented higher prevalence of peritraumatic distress, PTSD, and depression symptoms, compared to non-victims. The moderated-moderation model showed that sexual assault and exposure to the earthquake were positively associated with traumatic consequences (respectively, B = 0.560, p < 0.001; B = 0.196, p < 0.001), while social support was negatively associated with them (B = -0.095, p < 0.05). Results showed a triple interaction: women victim of sexual assault who were satisfied with received social support are less likely to develop traumatic consequences after being exposed to the earthquake(B = -0.141, p < 0.01).

CONCLUSIONS

By demonstrating the role of sexual assault in the development of mental health problems after the Haitian earthquake, this study shows the importance for clinicians to investigate interpersonal trauma experienced before or following natural disasters among survivors. Results also indicate the key role of family and communities to help survivors build resilience and coping strategies with their social support.

Migrations, trauma and mental health: A literature update on psychological assessment

INTRODUCTION

Migrants and refugees often face potentially traumatic events and post-migratory stressors. Upon arrival in the host country, they can be referred to mental health services to assess the impact of their previous experiences. These cross-cultural clinical encounters may raise questions, particularly regarding the assessment of mental health using models based on Western conceptions of psychopathology.

OBJECTIVES AND METHOD

The objective of the present non-systematic review of the literature is to discuss the psychological evaluation of post-traumatic reactions in migrants and refugees. More specifically, we present current research on psychopathology, resilience and post-traumatic development (PTG) among the migrant and refugee population. We also examine the cross-cultural validity of concepts such as Post-Traumatic Stress Disorder, resilience and PTG. Finally, we describe the most frequently used tools in cross-cultural psychological assessment and briefly reflect on the question of cultural sensitivity of mental health professionals. A bibliographic search was carried out using the databases: PILOTS, Pubmed, APA PsycNET, and Google Scholar using the following keywords: "migrants", "refugees", "posttraumatic stress disorder", "mental health", "Psychopathology", "risk factors", "protection factors", "posttraumatic growth" and "resilience". We have also reviewed the reference lists of articles encountered from database searches.

RESULTS

Responses to a potentially traumatic situation are multiple. Regarding the migrant and refugee population, the reviewed articles studied different post-traumatic reactions such as resilience, post-traumatic development, and psychopathologies. The most studied psychopathological responses were depression, anxiety and Post-traumatic Stress Disorder. After reviewing these studies, we asked the following question: considering the complexity of the migration process, what are the factors associated with the development of these different post-traumatic responses? Indeed, several individual and social factors before, during and after migration influence the mental health of individuals in a migration situation. Among the most cited risk factors identified were: to be a victim of or witness to violence in the country of origin and, after migration, to face post-migration difficulties such as asylum denial, to be in a precarious situation with regard to housing and work, as well as the difficulties linked to adaptation to the new culture. We have also described protective factors for the mental health of this population, such as: social support, psychological support, and a good quality of life in the host country. The reviewed articles also describe an important influence of cultural aspects on mental health, such as the perception of an event as traumatic. Although the authors of the reviewed articles accept this influence of culture on post-traumatic responses, most of the tools used to assess the mental health of migrants and refugees were created in a Western context. Studies show a growing concern with these cultural aspects, and certain tools that allow a more culturally sensitive evaluation, such as the "Cultural Formulation Interview", are being developed.

DISCUSSION AND CONCLUSION

Even if the concern with the sensitivity of the tools used in cross-cultural assessment seems to be more present in the international literature, researchers seem to encounter difficulties in better understanding the effects of culture on the mental health of individuals. With increasingly diverse societies, new research should not be based on participants' geographic or ethnic origins, but rather try to "unpack" culture with, for example, the exploration of the relationships between certain values or orientations and the different expressions of psychological distress. Finally, given the still lacking development in the field of cross-cultural research, certain practices, such as the participation of interpreters, the supervision of cultural mediators or the use of culturally sensitive tools, can help the clinician to maintain good practices with patients from different cultures in the diagnostic and psychotherapeutical processes.

Cultural risk factors of suicidal behavior among adolescents in Kazakhstan

Youth suicide is becoming a serious problem in Kazakhstan. According to UNICEF reports, the risk of suicidal behavior among adolescents (15-19 years) in Kazakhstan is three times higher than in the Commonwealth of Independent States (CIS). Despite the urgency of the problem, there are currently no psychological studies of the causes of suicide. In this article, we identify several cultural and historical factors and associated risks that, in our opinion, should be considered in the study of the growth of adolescent suicide in Kazakhstan.

A systematic review of mental health programs among populations affected by the Ebola virus disease

OBJECTIVES

The Ebola virus disease (EVD) is associated with major mental health consequences (e.g., depression, anxiety, PTSD). Studies have shown a need for relevant and effective programs to address mental health consequences associated to EVD. This systematic review aimed to describe programs implemented following EVD outbreaks and to evaluate their effectiveness and relevance in order to provide evidence-based data to improve mental health services.

METHODS

We first searched EMBASE, PubMed, PsycINFO, PILOTS, Cochrane Library and MEDLINE for a systematic review on EVD and on MHPSS programs. Then, we searched the grey literature. The search generated 2827 publications. Eleven studies were retained according to the PRISMA statement.

RESULTS

This systematic review revealed that most programs were implemented by international organizations in collaboration with local partners. Many of them were implemented following WHO mhGAP and Psychological First Aid guidelines. Programs were implemented in hospitals, Ebola treatment centres, communities among different categories of individuals exposed to EVD (survivors, health workers and volunteers, other frontline workers, children, adults, etc.). Only two of the identified programs which integrated cultural factors were empirically evaluated. Results from the evaluations showed mental health improvement for both children and adults.

CONCLUSIONS

This study provides the first systematic review on MHPSS programs among communities affected by EVD. This study shows the need to increase efforts to systematically document and evaluate the implemented programs. Results also provide preliminary evidence about the value of culturally sensitive MHPSS programs and of the implication of local mental health professionals.

The mental health professional at the feet of the Ebola virus: individual treatment and global mental challenges

SummaryMental health professionals form an important component of the response teams currently working in the Democratic Republic of the Congo to treat what is historically the second-largest Ebola outbreak. They provide psychological treatment to patients under extraordinary conditions, helping them cope with anxiety and the daily death of other patients.Declaration of interestNone.

Cybervictimization and suicidality among French undergraduate Students: A mediation model

BACKGROUND

Most of the scientific literature on cyberbullying and psychosocial consequences associated is based on samples of adolescents. Also, despite their contributions, the few studies with emerging adults were conducted with small or single-site samples. The present study aimed to document the prevalence of cyberbullying among college students in France and the association between cybervictimization, psychological distress and suicidality.

METHODS

The sample included 4 626 French undergraduates. Participants answered to a cyberbullying scale that measured the frequency of victimization and distress associated. Suicidal ideations and attempts and emotional abuse from parents were also assessed.

RESULTS

The prevalence of cybervictimization was higher in male students than female students. Cybervictims of both genders reported more suicidal ideations and suicidal attempts than non-victims. Mediated model shows a complete mediation effect of psychological distress associated to cybervictimization on the relationship between cyberbullying and suicidality.

LIMITATIONS

The study relied on a cross-sectional design, and as such it is impossible to observe neither developmental trajectories of cybervictimization, nor the causality between the variables. Also, a more comprehensive questionnaire assessing different forms of cybervictimization would have allowed to examine further forms of cybervictimization and their impacts.

CONCLUSION

This study with a large sample leads to important cues for prevention and intervention programs. It highlights that cyberbullying is not only an adolescence concern; but also a young adult issue associated with negative consequences.

The aftermath of resilience in the global world

Just as there is an aftermath of trauma, there is reason to think of an aftermath of resilience, different from the resilience capacities developed after a trauma. The aftermath of resilience reflects the ability to activate resilient memory in response to traumatic memory in order to rebuild oneself. This is a major challenge for the global mental health of our fragile societies. The challenge is significant for France, Europe and the world. Beyond the overuse of the word resilience in scientific literature and the media, it contributes to the methodology, epistemology and politics of resilience.

Resilience in Haiti: is it culturally pathological?

Not for the first time in recent history, the people of Haiti have been obliged to fall back on their resilience strategies in the aftermath of Hurricane Matthew. Following the powerful earthquake that struck the country on 12 January 2010, the entire population had to find the resources to survive in the face of extensive material damage and loss of life: over 222 000 dead, more than 300 000 injured and between 4000 and 7000 amputees (UNDP, 2010).

Multiple traumas and resilience among street children in Haiti: Psychopathology of survival

In Haiti, as in several developing countries, the phenomenon of street children has become a major public health issue. These children are often victims of traumas and adverse life events. This article aimed to investigate traumas experienced by street children and their coping and resilience strategies used to deal with adversities in a logic of survival, relying on a mixed method approach. A group of 176 street children, aged 7-18 (n = 21 girls), recruited in Port-au-Prince, completed measures assessing PTSD, social support and resilience. Semi-structured interviews were conducted to document traumatic experiences, factors related to resilience and coping strategies. After performing statistical analyses to evaluate prevalence and predictors associated with PTSD, and level of social support satisfaction and resilience, qualitative analysis using a grounded theory approach was conducted. Results showed that street children experienced multiple traumas such as neglect, maltreatment, psychological, physical and sexual abuse. However, they also showed self-efficacy to face their traumatic experiences and few of them (less than 15%) obtained scores reaching clinical rates of PTSD, while a large majority presented a level of resilience between moderate to very high. A socio-ecological model of multiple traumas and a model of coping, survival and resilience strategies are conceptualized. Data provide a better understanding of the traumas experienced by street children, their coping and resilience strategies. Results underscore ways to develop practices to offer psychological support, social and vocational integration based on the real needs of these children, in a perspective of social justice.

Prevalence and determinants of post-traumatic stress disorder, anxiety and depression symptoms in street children survivors of the 2010 earthquake in Haiti, four years after

Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD=2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.

[Tutors of resiliency of children and adolescents living in camps in Port-au-Prince and surrounding cities]

OBJECTIVES

In the context of sustainable reconstruction of Haiti following the earthquake of January 12, 2010, this research analyses the processes of resilience and creators of young and adolescent Haitians. In particular, it examines the role of family, school, care institutions, beliefs, association networks, the state and the international community in the development of these processes. These strata are considered as human resources that may assist in the living of difficult experiences, and reconstruction-shoring research mainly aims to identify guardians' resilience among young and adolescent Haitians living in camps in Port-au-Prince and the other most affected cities after the nearby earthquake.

METHODOLOGY

From a questionnaire developed jointly with the University Lumière Lyon 2 (CRPPC) Editec and the State University of Haiti (UEH) in the context of research, individual interviews were conducted with a sample of n=1475 children and adolescents, 782 girls and 693 boys, 19% of whom were under the age of 6 years, 52% aged 6 to 15 years and 29% aged 15 to 20 years. This allowed the collection of their perception and representation of different elements, which serve as scaffolding to cope with the post-traumatic situation they experienced and to analyse and establish the correlation links between the tutors identified. Among the young people in the sample, 97% are mostly educated, and they remain in three cities that have been particularly affected by the earthquake: the capital Port-au-Prince, Leogane a commune of Port-au-Prince located in the department of the West, and Jacmel a commune of Haiti and head of the department of the South East. We enjoyed the perception and representation of children and adolescents on several potential guardians' resilience: family, school, health care institutions, places of worship, social and community networks, government and international organizations.

RESULTS

Some data concluded that tutors can actually be correlated and identified by sex and level of development topics. Analyses revealed that the majority of children had not lost their parents and said they feel safe with their families. Academic performance tended mostly to increase after the earthquake, young people perceived care as accessible and available, and the majority claim to be Protestant. They certify that they have many friends and have ties in the community and feel safe in the streets. The data show a positive dominance of religious practice and sense of trust in institutions of care on the part of girls while the boys claim to have more confidence in the State. The school performance is more important to those aged between 6-15 years, while the older ones practice less religion and rely less on the State and international organizations. These results suggest the importance of institutions such as the family, places of worship, educational institutions, health centres, community, etc.

Psychometric properties of the Haitian Creole version of the Resilience Scale with a sample of adult survivors of the 2010 earthquake

BACKGROUND

Resilience is defined as the ability of people to cope with disasters and significant life adversities. The present paper aims to investigate the underlying structure of the Creole version of the Resilience Scale and its psychometric properties using a sample of adult survivors of the 2010 earthquake.

METHODS

A parallel analysis was conducted to determine the number of factors to extract and confirmatory factor analysis was performed using a sample of 1355 adult survivors of the 2010 earthquake from people of specific places where earthquake occurred with an average age of 31.57 (SD=14.42). All participants completed the Creole version of Resilience Scale (RS), the Impact of Event Scale Revised (IES-R), the Beck Depression Inventory (BDI) and the Social Support Questionnaire (SQQ-6). To facilitate exploratory (EFA) and confirmatory factor analysis (CFA), the sample was divided into two subsamples (subsample 1 for EFA and subsample 2 for CFA).

RESULTS

Parallel analysis and confirmatory factor analysis results showed a good-fit 3-factor structure. The Cronbach α coefficient was .79, .74 and .72 respectively for the factor 1, 2 and 3 and correlated to each other. Construct validity of the Resilience scale was provided by significant correlation with measures of depression and social support satisfaction, but no correlation was found with posttraumatic stress disorder measure, except for factor 2.

CONCLUSIONS

The results reveal a different factorial structure including 25 items of the RS. However, the Haitian Creole version of RS is a valid and reliable measure for assessing resilience for adults in Haiti.

Evaluating the risks of school dropout amongst children in the care of the French child protection system: An exploratory study

The aim of this pilot study is to identify the best way of preventing and assessing the livelihood and risk of school dropout amongst children entrusted to the care of the French child protection system in the Département of Rhone. The sample comprised 91 children and adolescents aged 4- to 17-years-old, of whom 45 were girls. The data were gathered using a unique report including the items evaluating sociodemographic data and the School Dropout Risk Evaluation Questionnaire. The results show that the older these children get, the more they see their academic problems as revolving around themselves. The youngest amongst them attribute their problems to the quality of approach adopted in the environment while the older children tend to view themselves as the reason for their failure. Collaborative efforts are therefore necessary between all actors in order to prevent school dropout and to provide intervention as early as possible.

Prevalence of post-traumatic stress disorder and depression in two groups of children one year after the January 2010 earthquake in Haiti

BACKGROUND

More than 500 studies were conducted in Haiti following the January 12 of 2010 earthquake, yet few of them assessed mental health of the population. To our knowledge, none targeted the effectiveness of various methods used to treat survivors, whether adults or children

METHOD

Our study aimed to assess one year after the disaster, the effect of a specific psycho-social support offered to relocated children in Port-au-Prince compared with a control group.

RESULTS

The two groups were homogeneous in the intensity of the peritraumatic distress they experienced. We were unable to show a significant difference between both in the average scores for PTSD, nor for depression, nor in three out of the four sub-scales of the Child Behavior Check-List. In case children, 68% and 40.9%, respectively, and 50% and 20.5% of the control group, reported severe levels of the symptoms of PTSD and depression. These surprising results can be explained by the absence of equivalence in the two groups from a socio-demographic point of view and because subjects were not randomly selected in the recruitment process.

CONCLUSION

This study has not made it possible to indicate the effectiveness of a specific psycho-social support offered to children in the aftermath of the disaster. On the other hand, the sample illustrates the high prevalence (more than 50% for PTSD) of severe post-traumatic stress in this group of school-age children, one year after the earthquake. These results indicate that serious attention should be paid to the mental health aspects in reconstruction program for the country.

Long-term outcomes among child and adolescent survivors of the 2010 Haitian earthquake

BACKGROUND

We examined the prevalence and predictive factors of PTSD and depression in relation with peritraumatic distress, trauma exposure, and sociodemographic characteristics among children and adolescent who survived the 2010 Haiti's earthquake.

METHODS

We analyzed data collected between June and July 2012 from a sample of 872 participants aged 7 to 17 in 12 schools, door-to-door canvassing and two centers for street children at Port-au-Prince. Participants completed the Impact of Event Scale Revised (IES-R), Peritraumatic Distress Inventory, Child Depression Inventory 2 (CDI), and sociodemographic and traumatic exposure questionnaires.

RESULTS

Of 872 participants, respectively 322 (36.93%); and 403 (46.21%) reported a clinically significant symptoms of PTSD and depression, which were significantly higher among girls. The best predictive variables are peritraumatic distress for PTSD (β=0.53,P<.0001) a traumatic exposure for depression (β=0.23,P<.0001). The comorbidity between PTSD and depression symptoms is 22.25%.

CONCLUSIONS

This first study in children on the prevalence of PTSD and depression resulting from the 2010 Haiti earthquake demonstrates a need for improvement in treatment aimed at reducing PTSD and depression. Such treatment should be geared primarily toward girls, adolescents between the ages of 14 and 17 and those children and adolescents who have lost a family member in the earthquake.